Physical Therapy's Prominence in $64 Million Research Funding Program Reflected in Awards to Delitto, Duncan

Wednesday, February 25, 2015

Physical Therapy's Prominence in $64 Million Research Funding Program Reflected in Awards to Delitto, Duncan

Physical therapy is front-and-center in a high-profile $64 million program that seeks to anchor research to real-world practice: this week, the Patient-Centered Outcomes Institute (PCORI) announced that 2 of its 5 inaugural funds have been awarded to projects led by prominent physical therapy researchers Pamela Duncan PT, DPT, FAPTA, and Anthony Delitto , PT, PhD, FAPTA. Combined, the researchers will receive nearly $28 million in support.

Both projects are focused on getting physical therapists (PTs) involved in patient care early-on, and both will be conducted as "pragmatic clinical studies"—research that analyzes a care option’s effectiveness in real-life practice situations, such as typical hospital and outpatient care settings, with diverse patient populations. According to a PCORI news release, unlike standard clinical trials that "test whether a care approach works under optimized conditions with carefully selected patients in research centers," the findings from pragmatic studies "are more likely to be applicable to a wide variety of patients."

Duncan is professor of neurology at Wake Forest Baptist Medical Center. Delitto is associate dean of research at the University of Pittsburgh School of Health and Rehabilitation Sciences.

PCORI awarded $14 million for Duncan's project, which will involve stroke patients in 50 hospitals in North Carolina to find out if early discharge with ongoing support by PTs and other providers results in better daily function outcomes than longer hospital stays and standard transitional care. The study "will also consider caregiver strain, hospital readmission rates and mortality, use of health care, consistency of physician care, use of transitional care services, and death," Duncan writes in her summary of the project.

Delitto received $13.9 million in PCORI funding to look at the individual's transition from acute low back pain (LBP) to chronic LBP by focusing on 2 approaches in the outpatient primary care physician (PCP) setting—one "usual care" approach, and a second approach that would team up PCPs with PTs to provide cognitive behavioral therapy (CBT). Patients who have LBP and risk factors for moving from acute to a more persistent state of LBP will be the targeted population for the project, which will involve 12 PCP clinics in 5 different areas across the country. Delitto hopes to recruit 2,640 patients and acquire data on 2,400 over 6 months after enrollment.

"This study is designed to look at the value of a stronger partnership between primary care and physical therapy, particularly for painful musculoskeletal conditions," Delitto said. "A number of studies have come out detailing the success of the PCP plus PT-CBT approach, but they've all been conducted in Europe. Before we can recommend any approach, it should be thoroughly and rigorously tested in the US, with its unique health care system."

The program, with its focus on pragmatic trials, is intended to encourage exactly that kind of approach, according to PCORI Executive Director Joe Selby, MD, MPH.

"A critical feature of these studies is that they will involve all major stakeholder groups as partners, increasing the chances that the studies will be implemented in a useful way and analyzed with an eye toward implementation," said Selby in the news release. "And, if warranted, their results will be put to use in practice much more quickly than most research."

"We are extremely pleased that APTA member PT researchers are among those selected," said Paul A. Rockar Jr, PT, DPT, MS, APTA president in an association news release. "With improved patient outcomes based on evidence, we will be closer to achieving APTA's vision of transforming society by optimizing movement to improve the human experience."

PCORI is an independent, nonprofit organization authorized by Congress in 2010. Besides the Duncan and Delitto projects PCORI will also be funding research on breast cancer screening, the intensity of CT surveillance needed to detect lung cancers, and how a standing-order entry system advising physicians when to prescribe a medication to prevent infections reduces over- and underuse of this medication among patients with breast, lung, or colorectal cancer.

Comments

These are fantastic projects and the meat of what we need to know, what matters to patients and their families and contributes to lobbying for bills in favor of physical therapy intervention and reimbursement. PT is worth it. Congratulations to you both on your accomplishments thus far!

Posted by Hadiya Green
on 2/25/2015 9:33 PM

Congratulations on the largess. Please keep the subluxation of the sacral axis in mind in your search for another term for low back pain. You must come back to the sacroiliac joint as a causative factor in low back pain and it is still right where it has always been. Grieve was correct in 1981 when he said "Because of authoritarian and intimidating pronouncements about its nonexistence, the likelihood of the condition is not included among the many factors for assessment, and a careful comprehensive examination of the joint is not conducted.”
. Grieve, G. P. Common Vertebral Joint Problems. New York, NY. Churchill Livingstone Inc. 1981.